Population-level data on antenatal screening for proteinuria; India, Mozambique, Nigeria, Pakistan

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Clinical Trial Research

Background:

• Proteinuria assessment is a standard part of antenatal care, often used to screen for pre-eclampsia.
• The diagnostic and prognostic value of routine proteinuria screening in all pregnant women is debated, especially in resource-limited settings.

Purpose of the Study:

• To determine the prevalence and predictive value of proteinuria detected at the initial antenatal visit in pregnant women across diverse community settings.
• To evaluate the association between baseline proteinuria and subsequent pregnancy complications, including hypertension, maternal/perinatal mortality, and morbidity.

Main Methods:

• A cluster randomized trial involving 27 intervention clusters across four countries (India, Mozambique, Nigeria, Pakistan) from 2013-2017.
• Community health workers provided supplementary hypertension-oriented care, including visual dipstick proteinuria assessment.
• Multilevel regression models were used to compare proteinuria prevalence and analyze the relationship between baseline proteinuria and adverse outcomes.

Main Results:

• Baseline proteinuria was detected in less than 5% of eligible pregnancies, often in women who were normotensive at the time.
• No significant association was found between baseline proteinuria (≥1+ or ≥2+) and the incidence of hypertension, maternal mortality/morbidity, preterm birth, cesarean delivery, or perinatal mortality/morbidity.
• Restricting proteinuria testing to hypertensive pregnant women could lead to substantial projected annual cost savings in all participating countries.

Conclusions:

• The findings challenge current recommendations for routine proteinuria screening at the first antenatal visit for all pregnant women.
• Targeted proteinuria testing in pregnant women with hypertension is a potentially resource-saving strategy that warrants consideration.